Revenue Cycle Claims Specialist

NOCD

6d•$50,000 - $60,000•Remote

About The Position

The Revenue Cycle Specialist is a critical role within NOCD’s Revenue Cycle Management (RCM) team, responsible for managing the full insurance claims lifecycle—from eligibility verification through payment posting and denial resolution. This role requires a strong foundation in medical billing, insurance adjudication, and payer-specific guidelines, combined with a commitment to providing an excellent member experience. You will work cross-functionally with clinical, finance, and member support teams to ensure clean claim submission, timely reimbursement, and accurate member billing.

Requirements

2+ years of experience in medical billing, revenue cycle, or insurance claims processing
Working knowledge of the full claims lifecycle: eligibility verification, claims submission, denial management, appeals, and payment posting
Proficiency reading and interpreting Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERAs)
Solid understanding of insurance terminology: deductible, copay, coinsurance, prior authorization, coordination of benefits, and timely filing
Experience with CPT and ICD-10 coding for behavioral health or telehealth services
Familiarity with clearinghouse platforms and EHR systems
Strong attention to detail, analytical thinking, and ability to manage high-volume work queues
Excellent written and verbal communication skills; ability to explain billing clearly to members

Nice To Haves

Experience in behavioral health, mental health, or telehealth billing
Familiarity with Medicaid and Medicare billing requirements
Experience working denials and drafting payer appeals
Bachelor’s degree in healthcare administration, business, or related field
CPC, CPMA, or equivalent billing/coding certification

Responsibilities

Ability to verify member insurance eligibility and benefits prior to service, including deductible, copay, coinsurance, and out-of-pocket maximums
Submit clean claims electronically via EHR and clearinghouse platforms in compliance with payer-specific requirements
Ensure accurate coding of CPT, ICD-10, and modifier codes for behavioral health and telehealth services
Monitor claim status through payer portals and clearinghouses; identify and resolve rejections prior to adjudication
Manage claims across multiple payers
Review and work denial queues daily
Draft and submit clinical and administrative appeals with supporting documentation
Track appeal outcomes and escalate payer trends to leadership for contract and process improvements
Post insurance EOBs and ERAs accurately to patient accounts; reconcile payments against expected reimbursements
Identify and resolve underpayments, overpayments, and contractual adjustments in accordance with payer contracts
Process member refunds and balance transfers as appropriate
Respond to member billing inquiries via phone, email, and chat with accuracy and empathy
Explain EOBs, member responsibility amounts, and payment options clearly
Resolve billing disputes, identify errors, and apply corrections with appropriate documentation in the CRM and EHR
Maintain accurate records of all claims activity, member interactions, and billing adjustments
Adhere to HIPAA guidelines and company compliance standards in all communications and data handling
Report KPIs including denial rates, days in A/R, clean claim rates, and collection rates to manager on a regular cadence